Healthy Skin Maintainance

Another Great Article:

Maintaining healthy skin is essential for those with lymphedema because intact skin, with no scrapes or cuts, prevents bacteria from entering and causing infection.

The swelling of lymphedema stretches the skin and disrupts the skin’s basic protective mechanisms. Also, as lymphedema increases in severity the skin loses its elasticity, becomes thicker and scaly, and is increasingly at risk.

Avoid Smoking

Smoking causes narrowing of the blood vessels in the outermost layers of skin. This decreases blood flow, which depletes the skin of oxygen and nutrients (such as vitamin A) that are important to skin health.

These factors increase damage to the elastic fibers (elastin) and collagen, which give your skin strength and elasticity. When skin is already challenged by the damage of lymphedema, these additional stresses make the condition worse.

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

Lymphadema and Infections

Skin infections are something that people with Lymphadema deal with on a regular basis. Here is a good article with information about infections, and especially cellulitis which can become life threatening if left untreated.

Infections that can develop within the affected tissues are a serious complication associated with lymphedema. The risk of infection increases when lymphedema is not controlled by proper treatment and appropriate precautions.

The risks of lymphedema related infections are due to:

• The swelling of lymphedema compromises the health of the skin.
• Protein-rich stagnant lymph within these swollen tissues creates an environment that pathogens love!
• The deep skin folds resulting from the lymphedema are an ideal breeding ground for fungal infections.

Cellulitis

Cellulitis (sell-you-LYE-tis) is an infection that spreads freely, and quickly within the deeper tissues of the skin. Cellulitis becomes a life-threatening emergency when it spreads through the lymphatic or circulatory systems and can reach vital organs and other body parts.

Cellulitis is usually caused by the bacteria staphylococcus aureus that normally live on the skin. Any break in the skin, no matter how small, provides an opening for them to march in, multiply, and thrive. Even a simple act such as shaving a swollen leg could be an invitation to infection.

Symptoms of Cellulitis

• Malaise (a general sense of not feeling well)
• Flu-like symptoms
• Chills and fever
• Discoloration (redness, or streaky red lines)
• Rash
• Tissues that feel hot and tender
• Sudden swelling
• Itching
• Pain

This type of infection requires prompt treatment with antibiotics. See a Physician immediately if you think you may have a Cellulitis infection in a Lymphatic limb!!

Sonja M. Maul PT, CLT-LANA

Article on Swelling

This article was featured at "The Hook." I thought some of you might be interested in it. There is also some interesting issues and questions being raised in the comments section. It would be worth checking out.

DR. HOOK- Big head: Swelling of parts has many causes

by JOHN HONG, MD, published April 10, 2008

Ex-Governor Eliot Spitzer must have had a pretty big ego to think he could hire prostitutes and not get caught. Hello! But then again, it seems most powerful people get a swollen head and feel untouchable-- until they get a swollen lip when they get caught. Perhaps if the head did visibly swell up, it would keep people "in check" because it would be pretty unattractive.

Swelling, in medical terms, is called edema and occurs when fluid from the blood vessels leak into the soft tissues, such as into the legs, arms, lungs, and belly. Not sure what edema is like? Talk to a woman with PMS who's puffy all over-- and be sure to give her flowers.

Legs are the most likely place to have edema. People often complain their socks leave dents in their shins and calves, like a Tempur-Pedic mattress, a condition called "pitting edema." The edema can be uncomfortable from the tension. If the edema goes into the feet, wearing shoes can become difficult (yes, Imelda Marcos).

There are many causes of edema, but a big ego is not one of them. For the legs, poorly working veins are often the issue. If the blood doesn't go up the veins, the blood will pool in the legs and start to leak fluid. That's why folks with leg swelling often start the morning with thin legs-- lying in bed reduces the blood in the legs. Then being upright all day, gravity keeps blood down in the legs, and they begin to swell. In a worse-case scenario, a blood clot (DVT: deep venous thrombosis) backs up the pipes. A DVT usually causes fast edema and on one leg, and this requires immediate medical attention.

Poor lymphatics can lead to lymphedema. For example, a mastectomy with lymph node exploration can lead to permanent arm edema. Lymphedema (as well as edema due to thyroid disease) doesn't cause a pitting edema. (It's more of a Serta mattress.)

Salt! We all hear too much sodium (found in table salt) isn't good for us, and this is especially true for those with edema. If the kidneys can't excrete enough sodium, the pressure in the blood vessels pushes fluid into the soft tissue. It's like when I eat too many salty French fries on a hot day at an amusement park and my fingers swell up. Fluid depletion, like on a hot day in the park, can make the kidneys retain salt and water to worsen edema. Good working kidneys are important to prevent the body from swelling up like a sumo wrestler.

The heart pumps blood through the body-- and in particular to the kidneys-- for proper filtration. People with a weak heart, such as in congestive heart failure, can experience edema. If pulmonary edema occurs, the fluid in the lungs makes it hard to breathe, in particular when lying down, because blood pools in the lungs and they leak fluid. If it's bad enough, the person may have to sleep sitting up in a chair.

Cirrhosis of the liver can cause terrible edema throughout the body, but in particular the belly (ascites). The ascites often requires drainage via a needle. Also, protein levels can drop with cirrhosis, which leads to more edema.

Treatment for edema can be tricky. Compression stockings, exercise, and elevation of the legs might not create Betty Grable gams, but they can be pretty effective. Vascular surgeons can treat poorly working veins. Diuretics can help but also worsen edema depending on the underlying problem, so it's a balancing act.

For politicians with a big head, a little humble pie (minus any salt) might be the best treatment of all. Wouldn't that be swell?

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

Signs and Symptoms of Lymphedema

If you have come here wondering what lymphedema is, or wondering if you could possibly be developing it, here is a brief overview of symptoms that could indicate lymphedema.

Mostly a persons History, Observations, Measurements, Signs and Symptoms diagnose Lymphedema. These include:

• Swelling of a limb or body part.
• Swelling that is pitting in nature (pressure leaves an indentation (pit) that slowly fills in again).
• Swelling worsens over time.
• Sensation of heaviness and fatigue in the swollen limb.
• A dull aching in the limb.
• Repeated episodes of infection (Cellulitis).
• Clothing or Shoes do not fit.

There are a couple of studies that have been used to evaluate the lymphatic system, though not commonly used.

• Lymphoscintigraphy - a water-based contrast medium, which does not damage lymphatic tissues, makes it possible for a gamma camera to trace the flow of lymph. A computer generates images based on the data gathered by the gamma camera.
• Lymphangiography - A radiographic study of lymphatic structures following the injection of an oil-based contrast medium. (The purpose of the contrast medium is to make the lymph vessels and nodes visible on the x-rays.) This oil-based substance damages lymphatic vessels and this procedure is no longer used in the diagnosis of lymphedema.

A thorough history and evaluation is best at deciphering Lymphedema, and if further studies are indicated your therapist will consult with your physician to get them done.

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

Reality Check

Sometimes when you're feeling bad about your situation and the struggles you face with lymphedema, sometimes you just need a little perspective on things.

"Everyone deserves to be beautiful"

The Best Medicine

The most wasted of all days is one without laughter.
–E.E. Cummings

Lymphatic Fluid

Many people that I meet are puzzled by lymphadema. They usually ask me right away if a doctor can prescribe something that will remove the fluid. In my head I'm usually wanting to scream, "WOW what a mind blowing thought! Do you honestly not think I've already thought of THAT?!" but because I was raised with manners, I control myself and explain that the fluid that builds up in lymphedema isn't just "water" and can't be treated with diuretics. It's important to understand this because if you suffer with lymphedema you will probably have to explain this to many people in your life.

A really wonderful website called "Lymphedema People" has this very well written information about diuretics. Please visit this site for lots of wonderful information and support.

To understand why these agents are not recommended for the treatment of lymphedema we must first start with a basic definition of edema and lymphedema.

Edema: Abnormal pooling or build up of fluid in tissues. Generally caused by underlying medical conditions such as hypertension, varicose veins, thrombophlebitis, congestive heart failure, kidney failure steroid therapy, inflammatory reactions, or injury or trauma.

Diuretics are used to assist in the correction of the base problem causing the edema.

Lymphedema: A disorder in which “lymph” collects usually in a limb as a result of a congenital, hereditary malformation of the lymphatic system, or is a result secondary conditions such as node removal for biopsies, damage to the lymphatics from radiation, injury or trauma or by parasitic infection. Diuretics cannot help the underlying condition of lymphedema.

Why not use diuretics for lymphedema?

Perhaps the single most important consideration is in the composition of the lymph fluid caused by lymphedema. The fluid is a protein-rich substance that provides a breeding and nourishment center for bacteria. This has to be removed to lesson the risks of cellulitis and lymphangitis.

This fluid also has to be removed so as to prevent the formation and progression of fibrosis as lymphedema advances through the various stages.

Diuretics remove none of this waste fluid."

Lymphedema People founder Pat O'Connor also gives this advice to people whose doctors may recommend diuretics to treat lymphadema,

"Please, please don't get a diuretic to treat the lymphedema. Diuretics will in the long run make the lymphedema worse. They remove the water, but are unable to remove the heavier waste proteins in that fluid. That will cause tissue hardening, more swelling and even more susceptibility to infections.

Tell the doctor (don't ask - tell) that you want a referral to a Certified Lymhpedema Therapist."